July 18, 2006 -- On Tuesday two Louisiana nurses and a doctor were arrested on suspicion of murder for lethally injecting four patients with a cocktail of the painkiller morphine and Versed, a strong anti-anxiety medication, in the aftermath of Hurricane Katrina.
According to Louisiana State Attorney Charles Foti, this was not a case of negligence or assisted suicide, because the substances were injected into the patients without their knowledge, and the patients had not previously been on the medications.
"This is not euthanasia; it is homicide," Foti said.
However, the arrests have opened a debate within the medical community about how far a doctor may go to relieve patients who are suffering in dire situations.
For one, experts said that morphine and Versed are commonly used together to relieve pain for critical care patients.
"I don't doubt that if the situation is what I hear," with patients suffering in 100-degree heat and life-threatening conditions, "no doubt it was appropriate to receive some morphine. The question is, did they give too much?" said Dr. Maria Silveira, who specializes in end-of-life ethics issues at the University of Michigan Medical School.
Giving morphine alone is a finely tuned art. The amount depends on the patient's pain, weight and tolerance of narcotics. There is always the risk of a "double effect," or someone dying from the side effects. (Morphine can cause a person to stop breathing.)
"The double effect doctrine allows for the use of morphine in dying patients if the primary intention is to control pain rather than to hasten death," said Bill Allen, director of the program of bioethics and law at the University of Florida College of Medicine.
End-of-life experts and ethicists had a variety of opinions, but they all told ABC News that the medical and ethical issues facing medical staff in a crisis can be complicated.
The incident occurred on a floor at Memorial Medical Center in New Orleans that was dedicated to acute care patients. According to other press sources, witnesses said the hospital experienced severe conditions after the hurricane: Temperatures rose to 100 degrees and sanitation systems failed.
In such situations, tensions begin to rise quickly.
"People who would not normally behave by taking the life of another person might do so when the circumstances are extreme," said Dr. Jeffrey Bishop, a principal lecturer in medical ethics and law at Peninsula Medical School at the Universities of Exeter and Plymouth.
Bishop recounted a story of an acquaintance who was a special forces soldier in southeast Asia. He took the life of a wounded soldier he could not carry out of the jungle and who did not want to "rot or be captured" by the enemy.
"Unless you walk a mile in the shoes," Bishop said, "you know the saying."
Others emphasize that no one can accurately judge what happened there until more of the details are released.
"We need to remember that the doctor and nurses are innocent until proven guilty in a court of law where they are directly confronted by eye witnesses," said Laurie Zoloth, director of the center of bioethics, science and society at Northwestern University.
"We do not know the facts," said Zoloth.